Links Medical Practice

We carried out an announced comprehensive inspection at Links Medical Practice on 13 June 2019. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and outstanding for Well-led and the population group of people experiencing poor mental health (including dementia) because:

• The practice had set up and implemented a questionnaire for patients with autistic spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) to support referrals to the appropriate service.
• The practice offered an in-house service for diagnosing dementia and could evidence that they had detected 100% of their predicted dementia prevalence. The practice also initiated dementia medicines for patients in-house which reduced delays to secondary services.
• Despite significant uplift in patient numbers since 2014, the practice has maintained and improved its performance in terms of clinical outcomes and patient satisfaction, both in the terms of quality and accessibility of services.
• The practice were continually reviewing ways to improve their service and were working closely with the local commissioners to share their improvements for the benefit of the area. For example, they had recently recruited a chaplaincy service and were in the process of rolling this out across their primary care network.
• The practice demonstrated a strong leadership team with clear roles, responsibilities and lead areas and values. The culture of the practice and the way it was led and managed drove the delivery and improvement of high-quality, person-centred care.
• The leadership team were united in their commitment to deliver person centred care to their patient population. They effectively used the skills and abilities of their staff team and the resources available in the local community to provide accessible care, treatment and support to their patients. For example, the practice are the only voucher holder in the area for the Black Country Food Bank.
• The practice regularly reviewed their clinical and non-clinical data to support the growth of the practice population. The practice had undertaken a staffing reorganisation for efficiency and expansion. Staff had undergone external training to support the workflow of the practice. In addition, the practice implemented an extensive process of audit to ensure that document management personnel are practising in accordance with the written protocols and standard operating procedures (SOP’s).

We found have also rated the practice as good for providing safe, effective, caring and responsive services because:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• There were clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.
• The practice demonstrated a strong leadership team with clear roles, responsibilities and lead areas and values. The culture of the practice and the way it was led and managed drove the delivery and improvement of high-quality, person-centred care.
• The practice worked proactively with other organisations to ensure patients had access to a range of services to support their health and wellbeing.
• The practice was responsive to the needs of their population and had engaged with the local community such as mosques, churches, schools and local events to promote health initiatives.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• Patient feedback through comment cards, reviews on NHS Choices and patient consultations on the day of the inspection were positive about the caring nature of the practice.
• The practice had proactively identified and supported 140 carers, approximately 3% of the practice population. Patients identified as carers were eligible for a number of services such as flu vaccinations, and referrals for further support.
• The practice had a strong culture of learning and development. It regularly hosted medical students and was part of the research network.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

We saw areas of outstanding practice including:

• The practice had been awarded star practice in 2018 for their contribution to for their project work with schools for the ‘The Daily Mile’. This resulted in 1200 children running a mile a day routinely to reduce childhood obesity and improve health life expectancy.
• The practice could evidence that they had completed an opiate prescribing audit which had demonstrated a significant reduction of 30% in their repeated opiate prescribing in four months. They could demonstrate they were seventh across the Dudley CCG in their prescribing and at the time of the inspection were working with the CCG to replicate the work in other practices across Dudley.
• The practice could evidence that their prescribing data showed significant positive variation. For example, the practice had no hospital admissions due to medicines (HARMS) for the past twelve months. In addition, the practice had reviewed their frequent attenders and been proactive to reduce this down by 30% in the last six months.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care